Work

Association between 10-year atherosclerotic cardiovascular disease risk score and incident cardiovascular events across stages 0–3 of cardiovascular–kidney–metabolic syndrome: evidence from the China health and retirement longitudinal study (CHARLS)

Year: 2025

Type: article

Abstract: BACKGROUND: The cardiovascular-kidney-metabolic (CKM) syndrome framework integrates cardiometabolic risks. However, longitudinal evidence on the association between atherosclerotic cardiovascular disease 10-year risk (ASCVD10 year) scores and cardiovascular events across CKM syndrome stages remains limited in large aging populations. METHODS: We analyzed data from 4,565 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). ASCVD10 year scores were calculated using the China-PAR model at baseline (2012) and follow-up (2015), with cumulative risk scores derived accordingly. Participants were stratified into four trajectory clusters via k-means clustering based on ASCVD score dynamics. Logistic regression, restricted cubic spline models, subgroup analysis, and mediation analyses were conducted to assess associations and underlying pathways. RESULTS: Higher baseline and cumulative ASCVD10 year scores were significantly associated with increased risks of cardiovascular disease (CVD), heart disease, and stroke across CKM stages 0-3 (all P < 0.0001). Compared to the low-risk cluster, the highest-risk cluster exhibited a > 4-fold increased CVD risk (OR = 4.12, 95% CI: 2.81-6.02). Nonlinear associations were observed for CVD and heart disease, with inflection points indicating stronger effects at lower ASCVD ranges. Subgroup analyses revealed stronger associations in individuals ≤ 65 years, females, and those with hypertension or diabetes. Mediation analyses identified HbA1c, fasting glucose, and the TyG index as partial mediators, accounting for 3-6% of the total effect. CONCLUSIONS: ASCVD10 year scores, particularly cumulative exposure, are robust predictors of cardiovascular events across early CKM stages in middle-aged and older adults. These findings support the utility of longitudinal ASCVD10 year scores in preventive cardiometabolic strategies.

Source: BMC Cardiovascular Disorders

DOI: 10.1186/s12872-025-05295-2